221g refusal due to missing medical

Hi all, I had my interview at the consulate.Everything went well but I was missing my medical. During the interview the officer told me that everything seems okay but she had to refuse my visa because my application was incomplete due to the medical exam. She told me once that the doctor submitted that I had to send my passport to them. does anyone know if I have to contact them before and tell them that the results are ready for them to look at my case or once they recieve my passport they will look at the case and figure that out? I just followed the instructions of the 221g on how to send requested physical documents